Chest
Clinical InvestigationsWhole-Lung Lavage Under Hyperbaric Oxygen Conditions for Alveolar Proteinosis with Respiratory Failure
Section snippets
Bronchopulmonary Lavage Under Hyperbaric Oxygen Conditions
Unilateral whole-lung lavage was performed under hyperbaric oxygen conditions at 2 ATA (atmosphere absolute), in a large multiplace hyper-pressure walk-in chamber. Patients were pretreated with hydrocortisone (250 mg slow IV), starting 12 hours before the procedure. Each patient was lavaged first in the left lung (LLL) with, in total, 20 L of normal saline solution at 37°C. The right lung supported as much gas exchange as possible.
After two to three weeks’ recovery time, right lung lavage (RLL)
CASE 1
A 29-year-old man was referred to another hospital with progressive severe shortness of breath. A six-week trial of high-dose corticosteroid therapy was unsuccessful and a subsequent left-sided open-lung biopsy showed pulmonary alveolar proteinosis. The patient was then referred to us for further evaluation. He smoked up to 40 cigarettes a day for more than ten years. He worked as a roadmaker and lived in a rural area. Physical examination revealed a persistent unproductive cough, peripheral
DISCUSSION
Whole-lung lavage is a commonly used procedure in the treatment of pulmonary alveolar proteinosis3, 12 and is generally indicated when the arterial oxygen tension is less than 60 mm Hg (at rest) or when hypoxemia limits exercise.13 Conventional lavage is unsuitable, however, if highly afflicted patients are unable to maintain satisfactory gas exchange in the nonlavaged lung during the lavage procedure, and literature studies indicate a direct negative correlation between low initial PaO2 (and
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Cited by (22)
Therapeutic Whole Lung Lavage for Alveolar Proteinosis
2020, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :The following strategies may be utilized outright in patients with severe cardiac, pulmonary, or cardiopulmonary disease who may be intolerant of single-lung ventilation and predisposed to respiratory or cardiovascular compromise secondary to the instillation of large fluid volumes into the respiratory system. Performing WLL in a hyperbaric chamber may allow for tolerance of WLL by increasing PaO2 and arterial oxygen carrying capacity in patients who may not have been able to maintain their oxygenation under the typical circumstances.23 Using hyperbaric oxygen therapy as a contingency plan requires anticipation of factors including risk of exposing the patient, staff, and equipment to pressures higher than 1 atmosphere.
Whole lung lavage in the treatment of pulmonary alveolar proteinosis
2005, Journal of Perianesthesia NursingAnaesthesia and intensive care in the hyperbaric chamber
2002, Current Anaesthesia and Critical CarePulmonary alveolar proteinosis causing severe hypoxemic respiratory failure treated with sequential whole-lung lavage utilizing venovenous extracorporeal membrane oxygenation: A case report and review
2001, ChestCitation Excerpt :This is the basis for the hypoxemia commonly seen during WLL, and the reason for concern when a patient has refractory hypoxemia even prior to the procedure. An alternative to ECMO, which has been reported only in two cases for performing WLL in severely hypoxemic patients, is to use hyperbaric oxygen conditions in a large walk-in chamber.10 Oxygenation markedly improved in these two patients.
Surfactant protein A in bronchoalveolar lavage fluid
1992, The Journal of Laboratory and Clinical Medicine
Manuscript received July 30; revision accepted December 2.